A Qualitative Content Analysis of Nurses' Comfort and Employment of Workarounds With Electronic Documentation Systems in Home Care Practice

Using Electronic Software for Nursing Documentation in Nursing Students

AIM

This study aimed to assess the effect of using electronic software for nursing documentation on students.

METHOD

A quasi-experimental study was performed. The study population comprised 80 nursing students who were randomly divided into 2 groups. The software used for nursing documentation was designed according to the nursing process model. Students in the experimental group received theoretical and practical training. The control group attended a 1-day course on the nursing process model. A questionnaire was used to assess student satisfaction in nursing documentation. The data were analyzed using the Statistical Package for Social Sciences software 16 (Chicago, USA). The standard and comprehensiveness of documentation were analyzed using the summative content analysis with the MaxQDA 10 software (USA). TREND statement was followed for reporting.

RESULTS

The analysis showed that the mean scores of satisfaction in both groups increased significantly (p < .05). Furthermore, the result of the summative content analysis showed that the comprehensiveness and the standard of nursing documentation increased significantly in the experimental group (p < .05).

CONCLUSION

The findings confirmed the usefulness of electronic software in improving the standard and comprehensiveness of nursing documentation and the students' satisfaction.

Nurses' Electronic Medical Record Workarounds in a Tertiary Teaching Hospital

The objective of this study was to identify nurses' workarounds related to the use of electronic medical records in a tertiary teaching hospital. A total of 106 nurses (84.8%) using the electronic medical records completed 10-item questionnaires scored on a Likert scale and five open-ended questions with written responses. The numerical data were analyzed by descriptive statistics, and the written descriptions were categorized by meaning. The mean of the scored items ranged from 3.29 to 3.74. Approximately 38% to 50% of the participants reported (very) frequent workflow delays due to the use of the electronic medical records, and 46% to 64% reported (very) frequently using workarounds. Twenty-nine workarounds of the electronic medical records were due to electronic documentation, difficulty accessing the electronic medical records, medication administration, covering physician responsibilities, electronic communication with the physicians, respondents and physicians not skilled in using the electronic medical records, and connection failures between devices or machines and the electronic medical records. Although none of these identified workarounds were intended to be harmful, and certain workarounds were efficient for patient care and workflow, whether patient safety can be jeopardized by workarounds should be considered. This study contributes to the understanding of why and how workarounds occur in the hospital. It will be useful for achieving greater alignment between work contexts and the electronic medical record in the future.

Electronic Health Records in Danish Home Care and Nursing Homes: Inadequate Documentation of Care, Medication, and Consent

BACKGROUND

Electronic health records (EHRs) are used in long-term care to document the patients' condition, medication, and care, thereby supporting communication among caregivers and counteracting adverse drug events. However, the use of EHRs in long-term care has lagged behind EHR use in hospitals. In addition, most EHR research focuses on hospitals.

OBJECTIVE

This study gives a countrywide status of the documentation-related risks to patient safety in Danish home care and nursing homes, which are the two main providers of long-term care. Such a status provides a basis for national improvement efforts and international comparisons.

METHOD

The study is based on the reports from 893 inspections of home care and nursing homes by the Danish Patient Safety Authority (Styrelsen for Patientsikkerhed [STPS]).

RESULTS

As much as 69% of the inspected institutions document inadequately to an extent that has led to demands (i.e., issues the institution is legally obliged to rectify) or requests (i.e., issues the institution is merely asked to rectify) from STPS. Documentation issues about the patients' condition and care are present in nearly all institutions that receive demands (97%) and in the majority of those that receive requests (68%). Documentation issues about medication and consent to care are also common, but less so. The predominant risk to patient safety is incomplete documentation. It covers 72% of the documentation issues identified in the institutions that received demands; the remaining risks concern inconsistent (11%), nonexistent (7%), inaccessible (5%), and noncompliant (5%) documentation. The documentation inadequacies are similar for home care and nursing homes.

CONCLUSION

Inadequate EHR documentation is a widespread problem in Danish long-term care. While previous research mainly focuses on how EHR documentation affects patient medication, this study finds that documentation issues about the patients' condition and care are more prevalent and that issues about their consent are also common.

Assessment of Health Information Technology-Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System: A Qualitative Study of Aggregated Root Cause Analysis Data

IMPORTANCE

Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged.

OBJECTIVE

To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA) National Center for Patient Safety from January 1, 2013, to July 31, 2018.

MAIN OUTCOMES AND MEASURES

Common themes associated with the role of HIT-related safety concerns were identified and categorized according to the Health IT Safety framework for measuring, monitoring, and improving HIT safety. This framework includes 3 related domains (ie, safe HIT, safe use of HIT, and using HIT to improve safety) situated within an 8-dimensional sociotechnical model accounting for interacting technical and nontechnical variables associated with safety. Hence, themes identified enhanced understanding of the sociotechnical context and domain of HIT safety involved.

RESULTS

Of 214 RCAs categorized by the terms delay and outpatient submitted during the study period, 88 were identified as involving diagnostic delays and HIT, from which 172 unique HIT-related safety concerns were extracted (mean [SD], 1.97 [1.53] per RCA). Most safety concerns (82.6% [142 of 172]) involved problems with safe use of HIT, predominantly sociotechnical factors associated with people, workflow and communication, and a poorly designed human-computer interface. Fewer safety concerns involved problems with safe HIT (14.5% [25 of 172]) or using HIT to improve safety (0.3% [5 of 172]). The following 5 key high-risk areas for diagnostic delays emerged: managing electronic health record inbox notifications and communication, clinicians gathering key diagnostic information, technical problems, data entry problems, and failure of a system to track test results.

CONCLUSIONS AND RELEVANCE

This qualitative study of a national RCA data set suggests that interventions to reduce outpatient diagnostic delays could aim to improve test result management, interoperability, data visualization, and order entry, as well as to decrease information overload.